Clinical Research on Foot & Ankle
Open Access

Knee arthroplasty, commonly known as total knee replacement (TKR), is a widely performed surgical procedure aimed at relieving pain and restoring function in patients with severe knee arthritis or joint damage. This article provides a comprehensive review of knee arthroplasty, including indications, surgical techniques, post-operative care, complications, and future advancements in the field [1].

Knee osteoarthritis and rheumatoid arthritis are among the most common causes of knee joint degeneration, leading to pain, reduced mobility, and a decreased quality of life. Knee arthroplasty has emerged as an effective treatment option for patients with end-stage joint disease who do not respond to conservative management [2]. The first knee replacement procedure was performed in the 1960s, and since then, surgical techniques and implant materials have evolved significantly. Knee arthroplasty, commonly known as total knee replacement (TKR), is a widely performed surgical procedure aimed at alleviating pain and restoring function in patients with severe knee joint damage [3]. First introduced in the 1960s, knee arthroplasty has undergone significant advancements in surgical techniques, implant materials, and postoperative management [4]. The procedure is most commonly indicated for individuals suffering from end-stage osteoarthritis (OA), rheumatoid arthritis (RA), post-traumatic arthritis, or other degenerative joint diseases that severely impact mobility and quality of life [5]. With an aging global population and rising prevalence of obesity, the demand for knee arthroplasty is expected to increase exponentially, making it a vital area of research and clinical practice. The knee joint, a complex hinge joint composed of the femur, tibia, and patella, bears substantial mechanical stress during daily activities. Over time, degenerative changes in the articular cartilage can lead to pain, stiffness, and functional limitations. When conservative treatments such as physical therapy, anti-inflammatory medications, and intra-articular injections fail to provide sufficient relief, knee arthroplasty becomes a viable solution [6]. The primary goal of the procedure is to resurface the damaged joint with prosthetic components, typically made from metal alloys and high-grade polyethylene, to restore smooth articulation and reduce pain. In recent decades, innovations in implant design, surgical techniques, and perioperative care have significantly improved patient outcomes [7]. Enhanced recovery protocols, minimally invasive approaches, and robotic-assisted surgeries have contributed to better precision, reduced hospital stays, and faster rehabilitation. However, despite these advances, knee arthroplasty is not without challenges. Complications such as infection implant loosening, periprosthetic fractures, and residual pain remain concerns. Additionally, patient-specific factors such as age, comorbidities, and activity level can influence both the success and longevity of the procedure [8].

This comprehensive review aims to provide an in-depth analysis of knee arthroplasty, covering its historical evolution, indications, preoperative evaluation, surgical techniques, implant types, and postoperative management. Furthermore, it will explore potential complications, revision surgery considerations, and recent advancements in the field. By synthesizing current evidence and clinical best practices, this review will serve as a valuable resource for healthcare professionals, researchers, and patients seeking a thorough understanding of knee arthroplasty and its impact on musculoskeletal health and overall quality of life.

Indications for knee arthroplasty

Total knee arthroplasty (TKA) is indicated for patients experiencing:

• Severe knee pain that limits daily activities, such as walking or climbing stairs.
• Chronic knee inflammation and swelling that do not improve with medication or physical therapy.
• Deformity of the knee joint, such as bowing or valgus deformity.
• Failure of other treatment modalities, including corticosteroid injections and bracing.

Knee arthroplasty involves removing damaged cartilage and bone from the knee joint and replacing them with artificial implants. The primary types of knee replacements include:

Total Knee Arthroplasty (TKA) – Replacement of both femoral and tibial components with artificial implants.

Unicompartmental Knee Arthroplasty (UKA) – Partial knee replacement where only one compartment is replaced.

Patellofemoral Arthroplasty – Replacement of the patellofemoral joint in cases of isolated patellar arthritis.

Incision and Exposure – A surgical incision is made to expose the knee joint.

Bone Resurfacing – Damaged cartilage and bone are removed from the femur and tibia.

Implant Placement – Artificial components made of metal and polyethylene is secured using cement or cementless fixation.

Closure and Recovery – The wound is closed, and rehabilitation begins immediately post-surgery.

Post-operative care and rehabilitation

Successful knee arthroplasty depends significantly on post-operative care. The key aspects include:

Pain Management – Use of analgesics and anti-inflammatory medications.

Physical Therapy – Early mobilization and exercises to restore knee function.

Weight Management – Reducing stress on the artificial joint by maintaining a healthy weight.

Regular Follow-ups – Monitoring for complications such as infection or implant loosening.

While knee arthroplasty is generally safe, complications can occur, including:

Infection

Blood clots (deep vein thrombosis and pulmonary embolism)

Implant loosening or wear

Stiffness and limited range of motion

Nerve or vascular damage

Advances in knee arthroplasty

Recent innovations have improved outcomes in knee arthroplasty, such as:

Minimally Invasive Surgery (MIS) – Reducing incision size and tissue trauma.

Robotic-Assisted Surgery – Enhancing precision in implant positioning.

3D-Printed Custom Implants – Tailoring implants to the patient’s anatomy.

Biologic Therapies – Exploring cartilage regeneration techniques for joint preservation.

Conclusion

Knee arthroplasty is a highly effective procedure for managing end-stage knee arthritis and improving patients' quality of life. With continuous advancements in surgical techniques, implant materials, and rehabilitation protocols, outcomes continue to improve, reducing complications and enhancing long-term success. Future research in regenerative medicine and robotic-assisted techniques is expected to further refine knee replacement surgery. Knee arthroplasty has revolutionized the management of advanced knee joint pathology, offering patients significant pain relief, improved mobility, and enhanced quality of life. Over the past several decades, continuous advancements in surgical techniques, implant materials, and perioperative care have refined the procedure, resulting in better clinical outcomes and increased patient satisfaction. Enhanced recovery after surgery (ERAS) protocols, minimally invasive approaches, and the integration of computer navigation and robotic assistance have improved accuracy and reduced complications, highlighting the progressive nature of the field. Despite these advances, challenges remain. Long-term implant durability, especially in younger and more active patients, continues to be a concern, driving ongoing research into more wear-resistant materials and improved fixation methods. Complications such as periprosthetic joint infections, venous thromboembolism, and implant loosening require vigilant monitoring and innovative solutions. Additionally, the growing focus on patient-specific implants and personalized surgical planning underscores the importance of tailoring the procedure to each individual’s anatomy and functional needs.

The future of knee arthroplasty is poised for further innovation, with emerging technologies such as 3D-printed custom implants, artificial intelligence-assisted preoperative planning, and bioengineered cartilage replacements offering promising avenues for improved outcomes. Furthermore, patient-centered rehabilitation strategies, including digital health monitoring and telemedicine, are expected to enhance postoperative care and long-term recovery.

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